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April 17, 2014

Lifestyle counselling may open ‘can of worms’

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Patient resistance, insufficient time, a lack of funding and training are the main barriers GPs see to counselling patients about their bad habits such as smoking, drinking and being overweight.
A new study, published in the journal Family Practice found that the predominately private provision of GP services in Ireland has made changing the focus from curative care to lifestyle counselling slow.


However, most GPs and practice nurses regularly conduct lifestyle counselling and see it as important, the research, carried out by the ICGP and the Department of Health, Sport and Exercise Science at Waterford Institute of Technology, found.
GPs and practice nurses surveyed said delivering lifestyle counselling would require a considerable reorganisation of the general practice setting because, according to one GP, ‘the whole system is set up to write prescriptions’.
Some GPs also expressed concern that the GMS contract did not include preventative medicine. Lifestyle counselling was viewed as time-consuming and something that was tagged on to the end of a consultation and had the potential to ‘open a can of worms’, according to another GP.
Lifestyle counselling was seen as something that could impact on the profitability of a practice. A small number of GPs felt ‘business-minded practices would only consider engaging in activities that would generate an income’.
GPs also cited difficulty finding a suitable time to broach lifestyle behaviour change.
They said many patients became offended if they raised the topic. One female GP said she was conscious of not offending patients for fear of losing them to another practice.
“I’ve come back from working in a practice in England where people can’t doctor shop as much and I’m more conscious of it now starting off in a new practice, not wanting to antagonise people but being very conscious of the importance of it [lifestyle counselling],” she stated.
Participants said they needed more training to initiate counselling – on addiction behaviours and on how to provide advice regardless of their personal lifestyle choices. They also said a national initiative for public and private patients was needed, which would involve the GP initiating a lifestyle discussion and the practice nurse leading the programme and offering follow-up.